Healthcare Provider Details

I. General information

NPI: 1487178927
Provider Name (Legal Business Name): LORENZO OMANDAC APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 CENTENNIAL PKWY STE 100
LAS VEGAS NV
89149-4793
US

IV. Provider business mailing address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-3486
  • Fax: 702-869-3542
Mailing address:
  • Phone: 702-731-1616
  • Fax: 702-734-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN66219
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002579
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: